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Biswas S, Shahriar S, Bachay G, Arvanitis P, Jamoul D, Brunken WJ, Agalliu D. Glutamatergic neuronal activity regulates angiogenesis and blood-retinal barrier maturation via Norrin/β-catenin signaling. Neuron 2024:S0896-6273(24)00165-X. [PMID: 38599212 DOI: 10.1016/j.neuron.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/15/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
Interactions among neuronal, glial, and vascular components are crucial for retinal angiogenesis and blood-retinal barrier (BRB) maturation. Although synaptic dysfunction precedes vascular abnormalities in many retinal pathologies, how neuronal activity, specifically glutamatergic activity, regulates retinal angiogenesis and BRB maturation remains unclear. Using in vivo genetic studies in mice, single-cell RNA sequencing (scRNA-seq), and functional validation, we show that deep plexus angiogenesis and paracellular BRB maturation are delayed in Vglut1-/- retinas where neurons fail to release glutamate. By contrast, deep plexus angiogenesis and paracellular BRB maturation are accelerated in Gnat1-/- retinas, where constitutively depolarized rods release excessive glutamate. Norrin expression and endothelial Norrin/β-catenin signaling are downregulated in Vglut1-/- retinas and upregulated in Gnat1-/- retinas. Pharmacological activation of endothelial Norrin/β-catenin signaling in Vglut1-/- retinas rescues defects in deep plexus angiogenesis and paracellular BRB maturation. Our findings demonstrate that glutamatergic neuronal activity regulates retinal angiogenesis and BRB maturation by modulating endothelial Norrin/β-catenin signaling.
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Affiliation(s)
- Saptarshi Biswas
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA.
| | - Sanjid Shahriar
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA; Wyss Institute for Biologically Inspired Engineering, Boston, MA 02115, USA
| | - Galina Bachay
- Department of Ophthalmology and Visual Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Panos Arvanitis
- Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Danny Jamoul
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA; John Jay College of Criminal Justice, City University of New York, New York, NY 10019, USA
| | - William J Brunken
- Department of Ophthalmology and Visual Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Dritan Agalliu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA.
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Castellano CA, Sun T, Ravindranathan D, Hwang C, Balanchivadze N, Singh SRK, Griffiths EA, Puzanov I, Ruiz-Garcia E, Vilar-Compte D, Cárdenas-Delgado AI, McKay RR, Nonato TK, Ajmera A, Yu PP, Nadkarni R, O'Connor TE, Berg S, Ma K, Farmakiotis D, Vieira K, Arvanitis P, Saliby RM, Labaki C, El Zarif T, Wise-Draper TM, Zamulko O, Li N, Bodin BE, Accordino MK, Ingham M, Joshi M, Polimera HV, Fecher LA, Friese CR, Yoon JJ, Mavromatis BH, Brown JT, Russell K, Nanchal R, Singh H, Tachiki L, Moria FA, Nagaraj G, Cortez K, Abbasi SH, Wulff-Burchfield EM, Puc M, Weissmann LB, Bhatt PS, Mariano MG, Mishra S, Halabi S, Beeghly A, Warner JL, French B, Bilen MA. The impact of cancer metastases on COVID-19 outcomes: A COVID-19 and Cancer Consortium registry-based retrospective cohort study. Cancer 2024. [PMID: 38376917 DOI: 10.1002/cncr.35247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND COVID-19 can have a particularly detrimental effect on patients with cancer, but no studies to date have examined if the presence, or site, of metastatic cancer is related to COVID-19 outcomes. METHODS Using the COVID-19 and Cancer Consortium (CCC19) registry, the authors identified 10,065 patients with COVID-19 and cancer (2325 with and 7740 without metastasis at the time of COVID-19 diagnosis). The primary ordinal outcome was COVID-19 severity: not hospitalized, hospitalized but did not receive supplemental O2 , hospitalized and received supplemental O2 , admitted to an intensive care unit, received mechanical ventilation, or died from any cause. The authors used ordinal logistic regression models to compare COVID-19 severity by presence and specific site of metastatic cancer. They used logistic regression models to assess 30-day all-cause mortality. RESULTS Compared to patients without metastasis, patients with metastases have increased hospitalization rates (59% vs. 49%) and higher 30 day mortality (18% vs. 9%). Patients with metastasis to bone, lung, liver, lymph nodes, and brain have significantly higher COVID-19 severity (adjusted odds ratios [ORs], 1.38, 1.59, 1.38, 1.00, and 2.21) compared to patients without metastases at those sites. Patients with metastasis to the lung have significantly higher odds of 30-day mortality (adjusted OR, 1.53; 95% confidence interval, 1.17-2.00) when adjusting for COVID-19 severity. CONCLUSIONS Patients with metastatic cancer, especially with metastasis to the brain, are more likely to have severe outcomes after COVID-19 whereas patients with metastasis to the lung, compared to patients with cancer metastasis to other sites, have the highest 30-day mortality after COVID-19.
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Affiliation(s)
| | - Tianyi Sun
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Nino Balanchivadze
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan, USA
- Virginia Oncology Associates, US Oncology, Norfolk, Virginia, USA
| | - Sunny R K Singh
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan, USA
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | | | | | - Rana R McKay
- Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Taylor K Nonato
- Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Archana Ajmera
- Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Peter P Yu
- Hartford HealthCare Cancer Institute, Hartford, Connecticut, USA
| | - Rajani Nadkarni
- Hartford HealthCare Cancer Institute, Hartford, Connecticut, USA
| | | | - Stephanie Berg
- Loyola University Medical Center, Maywood, Illinois, USA
| | - Kim Ma
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Dimitrios Farmakiotis
- Brown University, Providence, Rhode Island, USA
- Lifespan Cancer Institute, Providence, Rhode Island, USA
| | - Kendra Vieira
- Brown University, Providence, Rhode Island, USA
- Lifespan Cancer Institute, Providence, Rhode Island, USA
| | | | - Renee M Saliby
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Chris Labaki
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Talal El Zarif
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Olga Zamulko
- University of Cincinnati Cancer Center, Cincinnati, Ohio, USA
| | - Ningjing Li
- University of Cincinnati Cancer Center, Cincinnati, Ohio, USA
| | - Brianne E Bodin
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Matthew Ingham
- Columbia University Irving Medical Center, New York, New York, USA
| | - Monika Joshi
- Penn State Health/Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Hyma V Polimera
- Penn State Health/Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Leslie A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | | | - James J Yoon
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | | | | | - Karen Russell
- Tallahassee Memorial Healthcare, Tallahassee, Florida, USA
| | - Rahul Nanchal
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Lisa Tachiki
- University of Washington and Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Gayathri Nagaraj
- Loma Linda University Cancer Center, Loma Linda, California, USA
| | - Kimberly Cortez
- Loma Linda University Cancer Center, Loma Linda, California, USA
| | - Saqib H Abbasi
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | | | | | | | - Sanjay Mishra
- Brown University, Providence, Rhode Island, USA
- Lifespan Cancer Institute, Providence, Rhode Island, USA
| | - Susan Halabi
- Duke Cancer Institute at Duke University Medical Center, Durham, North Carolina, USA
| | - Alicia Beeghly
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Benjamin French
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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3
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Guermazi D, Arvanitis P, Vieira K, Warner JL, Farmakiotis D. Oral antivirals for COVID-19 among patients with cancer. Res Sq 2024:rs.3.rs-3876022. [PMID: 38343793 PMCID: PMC10854279 DOI: 10.21203/rs.3.rs-3876022/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Purpose Immunocompromised individuals, such as those diagnosed with cancer, are at a significantly higher risk for severe illness and mortality when infected with SARS-CoV-2 (COVID-19) than the general population. Two oral antiviral treatments are approved for COVID-19: Paxlovid® (nirmatrelvir/ritonavir) and Lagevrio® (molnupiravir). There is a paucity of data regarding the benefit from these antivirals among immunocompromised patients with cancer, and recent studies have questioned their efficacy among vaccinated patients, even those with risk factors for severe COVID-19. Methods We evaluated the efficacy and safety of nirmatrelvir/ritonavir and molnupiravir in preventing severe illness and death using our database of 457 patients with cancer and COVID-19 from Brown University-affiliated hospitals. 67 patients received nirmatrelvir/ritonavir or molnupiravir and were compared to 56 concurrent controls who received no antiviral treatment despite being eligible to receive it. Results Administration of nirmatrelvir/ritonavir or molnupiravir was associated with improved survival and lower 90-day all-cause and COVID-19-attributed mortality (p<0.05) and with lower peak O2 requirements (ordinal odds ratio [OR] 1.52, 95% confidence interval [CI] 0.92-2.56). Conclusion Acknowledging the small size of our sample as a limitation, we concluded that early antiviral treatment might be beneficial to immunocompromised individuals, particularly those with cancer, when infected with SARS-CoV-2. Larger-scale, well-stratified studies are needed in this patient population.
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Affiliation(s)
| | | | - Kendra Vieira
- The Warren Alpert Medical School of Brown University
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4
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Biswas S, Shahriar S, Bachay G, Arvanitis P, Jamoul D, Brunken WJ, Agalliu D. Glutamatergic neuronal activity regulates angiogenesis and blood-retinal barrier maturation via Norrin/β-catenin signaling. bioRxiv 2024:2023.07.10.548410. [PMID: 37503079 PMCID: PMC10369888 DOI: 10.1101/2023.07.10.548410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Interactions among neuronal, glial and vascular components are crucial for retinal angiogenesis and blood-retinal barrier (BRB) maturation. Although synaptic dysfunction precedes vascular abnormalities in many retinal pathologies, how neuronal activity, specifically glutamatergic activity, regulates retinal angiogenesis and BRB maturation remains unclear. Using in vivo genetic studies in mice, single-cell RNA-sequencing and functional validation, we show that deep plexus angiogenesis and paracellular BRB maturation are delayed in Vglut1 -/- retinas where neurons fail to release glutamate. In contrast, deep plexus angiogenesis and paracellular BRB maturation are accelerated in Gnat1 -/- retinas where constitutively depolarized rods release excessive glutamate. Norrin expression and endothelial Norrin/β-catenin signaling are downregulated in Vglut1 -/- retinas, and upregulated in Gnat1 -/- retinas. Pharmacological activation of endothelial Norrin/β-catenin signaling in Vglut1 -/- retinas rescued defects in deep plexus angiogenesis and paracellular BRB maturation. Our findings demonstrate that glutamatergic neuronal activity regulates retinal angiogenesis and BRB maturation by modulating endothelial Norrin/β-catenin signaling.
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Arvanitis P, Lerner AH, Vieira K, Almaghlouth N, Farmakiotis D. Outpatient anti-spike monoclonal antibody administration is associated with decreased morbidity and mortality among patients with cancer and COVID-19. Clin Exp Med 2023; 23:2739-2748. [PMID: 36780118 PMCID: PMC9923655 DOI: 10.1007/s10238-023-01019-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023]
Abstract
Patients with cancer have many comorbidities that increase their risk of death from Coronavirus disease 2019 (COVID-19). Anti-spike monoclonal antibodies (mAbs) reduce the risk of hospitalization or death from COVID-19 in the general population. To our knowledge, no studies have focused on the clinical efficacy of mAbs compared to no outpatient treatment exclusively among patients with solid tumors and hematologic malignancies, who are often excluded from clinical trials. We studied patients with cancer who had COVID-19 between 11.9.2020 and 7.21.2022 and received mAbs in an outpatient setting. We compared hospitalization and mortality rates to those of patients with cancer concurrently diagnosed with COVID-19, who were eligible for mAbs, but did not receive any outpatient treatment. 63 patients received mAbs and 89 no outpatient treatment. Administration of mAbs was associated with lower 90-day hospitalization (20.6% vs. 60.7%, p <0.001), all-cause (6.3% vs. 19.1%, p 0.025) and COVID-19-attributed (3.2% vs. 14.6%, p 0.019) mortality rates, and lower peak O2 requirements (ordinal Odds Ratio [OR] = 0.33, 95% Confidence Intervals [CI] = 0.20-0.53). Administration of mAbs (aHR 0.21, p <0.001), age (≥ 60 years, adjusted Hazard Ratio [aHR] 1.86, p=0.033), and metastases (aHR 0.41, p 0.007) were independently associated with hospitalization. mAb treatment remained significantly associated with all-cause (aHR 0.27, p 0.019) and COVID-19-attributed (aHR 0.19, p 0.031) mortality, after adjustment for other factors. mAb administration was associated with improved clinical outcomes among vulnerable patients with cancer and COVID-19. With no mAbs approved currently for treatment against the prevalent circulating variants, the development of new mAbs should be a research priority.
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Affiliation(s)
- Panos Arvanitis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA
| | - Alexis Hope Lerner
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA
| | - Kendra Vieira
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA
| | - Nouf Almaghlouth
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA.
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6
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Guermazi D, Arvanitis P, Farmakiotis D. Molnupiravir efficacy among immunocompromised patients with COVID-19: no proof of concept. Infection 2023; 51:1593-1595. [PMID: 37004695 PMCID: PMC10066965 DOI: 10.1007/s15010-023-02027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Dorra Guermazi
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA
| | - Panos Arvanitis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA.
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7
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Wayne CR, Bremner L, Faust TE, Durán-Laforet V, Ampatey N, Ho SJ, Feinberg PA, Arvanitis P, Ciric B, Ruan C, Elyaman W, Delaney SL, Vargas WS, Swedo S, Menon V, Schafer DP, Cutforth T, Agalliu D. Distinct Th17 effector cytokines differentially promote microglial and blood-brain barrier inflammatory responses during post-infectious encephalitis. bioRxiv 2023:2023.03.10.532135. [PMID: 37215000 PMCID: PMC10197575 DOI: 10.1101/2023.03.10.532135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Group A Streptococcus (GAS) infections can cause neuropsychiatric sequelae in children due to post-infectious encephalitis. Multiple GAS infections induce migration of Th17 lymphocytes from the nose into the brain, which are critical for microglial activation, blood-brain barrier (BBB) and neural circuit impairment in a mouse disease model. How endothelial cells (ECs) and microglia respond to GAS infections, and which Th17-derived cytokines are essential for these responses are unknown. Using single-cell RNA sequencing and spatial transcriptomics, we found that ECs downregulate BBB genes and microglia upregulate interferon-response, chemokine and antigen-presentation genes after GAS infections. Several microglial-derived chemokines were elevated in patient sera. Administration of a neutralizing antibody against interleukin-17A (IL-17A), but not ablation of granulocyte-macrophage colony-stimulating factor (GM-CSF) in T cells, partially rescued BBB dysfunction and microglial expression of chemokine genes. Thus, IL-17A is critical for neuropsychiatric sequelae of GAS infections and may be targeted to treat these disorders.
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Arvanitis P, Lerner AH, Vieira K, Almaghlouth N, Farmakiotis D. Outpatient anti-spike monoclonal antibody administration is associated with decreased morbidity and mortality among patients with cancer and COVID-19. Res Sq 2023:rs.3.rs-2433445. [PMID: 36711556 PMCID: PMC9882636 DOI: 10.21203/rs.3.rs-2433445/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patients with cancer have many comorbidities that increase their risk of death from Coronavirus disease 2019 (COVID-19). Anti-spike monoclonal antibodies (mAbs) reduce the risk of hospitalization or death from COVID-19 in the general population. To our knowledge, no studies have focused on the clinical efficacy of mAbs compared to no outpatient treatment exclusively among patients with solid tumors and hematologic malignancies, who are often excluded from clinical trials. METHODS We studied patients with cancer who had COVID-19 between 11.9.2020 and 7.21.2022 and received mAbs in an outpatient setting. We compared hospitalization and mortality rates to those of patients with cancer concurrently diagnosed with COVID-19, who were eligible for mAbs, but did not receive any outpatient treatment. RESULTS 63 patients received mAbs and 89 no outpatient treatment. Administration of mAbs was associated with lower 90-day hospitalization (20.6% vs. 60.7%, p<0.001), all-cause (6.3% vs. 19.1%, p=0.025) and COVID-19-attributed (3.2% vs. 14.6%, p=0.019) mortality rates, and lower peak O2 requirements (ordinal Odds Ratio [OR]=0.33, 95%Confidence Intervals [CI]=0.20-0.53). Administration of mAbs (aHR 0.21, p<0.001), age (≥ 60 years, adjusted Hazard Ratio [aHR] 1.86, p=0.033), and metastases (aHR 0.41, p=0.007) were independently associated with hospitalization. mAb treatment remained significantly associated with all-cause (aHR 0.27, p=0.019) and COVID-19-attributed (aHR 0.19, p=0.031) mortality, after adjustment for other factors. CONCLUSIONS mAb administration was associated with improved clinical outcomes among vulnerable patients with cancer and COVID-19. With no mAbs approved currently for treatment against the prevalent circulating variants, the development of new mAbs should be a research priority.
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Affiliation(s)
- Panos Arvanitis
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University
| | - Alexis Hope Lerner
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University
| | - Kendra Vieira
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University
| | - Nouf Almaghlouth
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University
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Bakouny Z, Labaki C, Grover P, Awosika J, Gulati S, Hsu CY, Alimohamed SI, Bashir B, Berg S, Bilen MA, Bowles D, Castellano C, Desai A, Elkrief A, Eton OE, Fecher LA, Flora D, Galsky MD, Gatti-Mays ME, Gesenhues A, Glover MJ, Gopalakrishnan D, Gupta S, Halfdanarson TR, Hayes-Lattin B, Hendawi M, Hsu E, Hwang C, Jandarov R, Jani C, Johnson DB, Joshi M, Khan H, Khan SA, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Matar S, McKay RR, Mishra S, Moria FA, Nizam A, Nock NL, Nonato TK, Panasci J, Pomerantz L, Portuguese AJ, Provenzano D, Puc M, Rao YJ, Rhodes TD, Riely GJ, Ripp JJ, Rivera AV, Ruiz-Garcia E, Schmidt AL, Schoenfeld AJ, Schwartz GK, Shah SA, Shaya J, Subbiah S, Tachiki LM, Tucker MD, Valdez-Reyes M, Weissmann LB, Wotman MT, Wulff-Burchfield EM, Xie Z, Yang YJ, Thompson MA, Shah DP, Warner JL, Shyr Y, Choueiri TK, Wise-Draper TM, Gandhi R, Gartrell BA, Goel S, Halmos B, Makower DF, O' Sullivan D, Ohri N, Portes M, Shapiro LC, Shastri A, Sica RA, Verma AK, Butt O, Campian JL, Fiala MA, Henderson JP, Monahan RS, Stockerl-Goldstein KE, Zhou AY, Bitran JD, Hallmeyer S, Mundt D, Pandravada S, Papaioannou PV, Patel M, Streckfuss M, Tadesse E, Gatson NTN, Kundranda MN, Lammers PE, Loree JM, Yu IS, Bindal P, Lam B, Peters MLB, Piper-Vallillo AJ, Egan PC, Farmakiotis D, Arvanitis P, Klein EJ, Olszewski AJ, Vieira K, Angevine AH, Bar MH, Del Prete SA, Fiebach MZ, Gulati AP, Hatton E, Houston K, Rose SJ, Steve Lo KM, Stratton J, Weinstein PL, Garcia JA, Routy B, Hoyo-Ulloa I, Dawsey SJ, Lemmon CA, Pennell NA, Sharifi N, Painter CA, Granada C, Hoppenot C, Li A, Bitterman DS, Connors JM, Demetri GD, Florez (Duma) N, Freeman DA, Giordano A, Morgans AK, Nohria A, Saliby RM, Tolaney SM, Van Allen EM, Xu WV, Zon RL, Halabi S, Zhang T, Dzimitrowicz H, Leighton JC, Graber JJ, Grivas P, Hawley JE, Loggers ET, Lyman GH, Lynch RC, Nakasone ES, Schweizer MT, Vinayak S, Wagner MJ, Yeh A, Dansoa Y, Makary M, Manikowski JJ, Vadakara J, Yossef K, Beckerman J, Goyal S, Messing I, Rosenstein LJ, Steffes DR, Alsamarai S, Clement JM, Cosin JA, Daher A, Dailey ME, Elias R, Fein JA, Hosmer W, Jayaraj A, Mather J, Menendez AG, Nadkarni R, Serrano OK, Yu PP, Balanchivadze N, Gadgeel SM, Accordino MK, Bhutani D, Bodin BE, Hershman DL, Masson C, Alexander M, Mushtaq S, Reuben DY, Bernicker EH, Deeken JF, Jeffords KJ, Shafer D, Cárdenas AI, Cuervo Campos R, De-la-Rosa-Martinez D, Ramirez A, Vilar-Compte D, Gill DM, Lewis MA, Low CA, Jones MM, Mansoor AH, Mashru SH, Werner MA, Cohen AM, McWeeney S, Nemecek ER, Williamson SP, Peters S, Smith SJ, Lewis GC, Zaren HA, Akhtari M, Castillo DR, Cortez K, Lau E, Nagaraj G, Park K, Reeves ME, O'Connor TE, Altman J, Gurley M, Mulcahy MF, Wehbe FH, Durbin EB, Nelson HH, Ramesh V, Sachs Z, Wilson G, Bardia A, Boland G, Gainor JF, Peppercorn J, Reynolds KL, Rosovsky RP, Zubiri L, Bekaii-Saab TS, Joyner MJ, Riaz IB, Senefeld JW, Shah S, Ayre SK, Bonnen M, Mahadevan D, McKeown C, Mesa RA, Ramirez AG, Salazar M, Shah PK, Wang CP, Bouganim N, Papenburg J, Sabbah A, Tagalakis V, Vinh DC, Nanchal R, Singh H, Bahadur N, Bao T, Belenkaya R, Nambiar PH, O’Cearbhaill RE, Papadopoulos EB, Philip J, Robson M, Rosenberg JE, Wilkins CR, Tamimi R, Cerrone K, Dill J, Faller BA, Alomar ME, Chandrasekhar SA, Hume EC, Islam JY, Ajmera A, Brouha SS, Cabal A, Choi S, Hsiao A, Jiang JY, Kligerman S, Park J, Razavi P, Reid EG, Bhatt PS, Mariano MG, Thomson CC, Glace M(G, Knoble JL, Rink C, Zacks R, Blau SH, Brown C, Cantrell AS, Namburi S, Polimera HV, Rovito MA, Edwin N, Herz K, Kennecke HF, Monfared A, Sautter RR, Cronin T, Elshoury A, Fleissner B, Griffiths EA, Hernandez-Ilizaliturri F, Jain P, Kariapper A, Levine E, Moffitt M, O'Connor TL, Smith LJ, Wicher CP, Zsiros E, Jabbour SK, Misdary CF, Shah MR, Batist G, Cook E, Ferrario C, Lau S, Miller WH, Rudski L, Santos Dutra M, Wilchesky M, Mahmood SZ, McNair C, Mico V, Dixon B, Kloecker G, Logan BB, Mandapakala C, Cabebe EC, Jha A, Khaki AR, Nagpal S, Schapira L, Wu JTY, Whaley D, Lopes GDL, de Cardenas K, Russell K, Stith B, Taylor S, Klamerus JF, Revankar SG, Addison D, Chen JL, Haynam M, Jhawar SR, Karivedu V, Palmer JD, Pillainayagam C, Stover DG, Wall S, Williams NO, Abbasi SH, Annis S, Balmaceda NB, Greenland S, Kasi A, Rock CD, Luders M, Smits M, Weiss M, Chism DD, Owenby S, Ang C, Doroshow DB, Metzger M, Berenberg J, Uyehara C, Fazio A, Huber KE, Lashley LN, Sueyoshi MH, Patel KG, Riess J, Borno HT, Small EJ, Zhang S, Andermann TM, Jensen CE, Rubinstein SM, Wood WA, Ahmad SA, Brownfield L, Heilman H, Kharofa J, Latif T, Marcum M, Shaikh HG, Sohal DPS, Abidi M, Geiger CL, Markham MJ, Russ AD, Saker H, Acoba JD, Choi H, Rho YS, Feldman LE, Gantt G, Hoskins KF, Khan M, Liu LC, Nguyen RH, Pasquinelli MM, Schwartz C, Venepalli NK, Vikas P, Zakharia Y, Friese CR, Boldt A, Gonzalez CJ, Su C, Su CT, Yoon JJ, Bijjula R, Mavromatis BH, Seletyn ME, Wood BR, Zaman QU, Kaklamani V, Beeghly A, Brown AJ, Charles LJ, Cheng A, Crispens MA, Croessmann S, Davis EJ, Ding T, Duda SN, Enriquez KT, French B, Gillaspie EA, Hausrath DJ, Hennessy C, Lewis JT, Li X(L, Prescott LS, Reid SA, Saif S, Slosky DA, Solorzano CC, Sun T, Vega-Luna K, Wang LL, Aboulafia DM, Carducci TM, Goldsmith KJ, Van Loon S, Topaloglu U, Moore J, Rice RL, Cabalona WD, Cyr S, Barrow McCollough B, Peddi P, Rosen LR, Ravindranathan D, Hafez N, Herbst RS, LoRusso P, Lustberg MB, Masters T, Stratton C. Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19. JAMA Oncol 2023; 9:128-134. [PMID: 36326731 PMCID: PMC9634600 DOI: 10.1001/jamaoncol.2022.5357] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Importance Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration ClinicalTrials.gov Identifier: NCT04354701.
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Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Punita Grover
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Joy Awosika
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saif I Alimohamed
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | | | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Arielle Elkrief
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Omar E Eton
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | | | | | | | | | | | | | | | | | | | | | - Mohamed Hendawi
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Emily Hsu
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, Michigan
| | - Roman Jandarov
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Shaheer A Khan
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Natalie Knox
- Loyola University Medical Center, Maywood, Illinois
| | - Vadim S Koshkin
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | | | - Daniel H Kwon
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | - Sara Matar
- Hollings Cancer Center, MUSC, Charleston
| | - Rana R McKay
- Moores Cancer Center, UCSD, San Diego, California
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nora L Nock
- Case Comprehensive Cancer Center, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
| | | | - Justin Panasci
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | - Yuan J Rao
- George Washington University, Washington, DC
| | | | | | - Jacob J Ripp
- University of Kansas Medical Center, Kansas City
| | - Andrea V Rivera
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Andrew L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Justin Shaya
- Moores Cancer Center, UCSD, San Diego, California
| | - Suki Subbiah
- Stanley S. Scott Cancer Center, LSU, New Orleans, Louisiana
| | - Lisa M Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - Zhuoer Xie
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael A Thompson
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin.,Tempus Labs, Chicago, Illinois
| | - Dimpy P Shah
- Mays Cancer Center, UT Health, San Antonio, Texas
| | | | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Omar Butt
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ang Li
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Lau
- for the COVID-19 and Cancer Consortium
| | | | - Kyu Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ting Bao
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ji Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin Cook
- for the COVID-19 and Cancer Consortium
| | | | - Susie Lau
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anup Kasi
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li C Liu
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | - Chris Su
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tan Ding
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | - Sara Saif
- for the COVID-19 and Cancer Consortium
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Lerner AH, Arvanitis P, Vieira K, Klein EJ, Farmakiotis D. mRNA vaccination decreases COVID-19-associated morbidity and mortality among organ transplant recipients: a contemporary cohort study. Open Forum Infect Dis 2022; 9:ofac503. [PMID: 36324327 PMCID: PMC9619466 DOI: 10.1093/ofid/ofac503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background Organ transplant recipients (OTRs) are less protected from vaccination than immunocompetent hosts. Additional vaccine doses have shown increased immunogenicity. Few studies have assessed their clinical efficacy, particularly against Omicron variants, as most included patients from earlier phases of the pandemic, with higher base mortality rates. Methods We studied adult OTRs who had coronavirus disease 2019 (COVID-19) between 12/15/21 and 5/25/22. We compared clinical outcomes between those who had received 2 or ≥3 doses of an mRNA vaccine and concurrent unvaccinated controls. Results Among 103 OTRs, vaccination was associated with lower 90-day mortality (unvaccinated vs 2 vs ≥3 doses: 25% vs 7% vs 3%; P = .003), hospital (unvaccinated vs 2 vs ≥3 doses: 56% vs 37% vs 27%; P = .018) and intensive care unit (ICU; unvaccinated vs 2 vs ≥3 doses: 25% vs 15% vs 3%; P = .001) admission rates, and peak O2 requirements (ordinal scale Kendall’s tau b = –0.309 [lower scores, ie, O2 requirements with more vaccine doses]; P = .003). Age (age >60 years: adjusted hazard ratio [aHR], 7.73; P = .016; administration of antispike monoclonal antibody: aHR, 0.17; P = .042) and vaccination, especially with ≥3 doses (aHR, 0.105; P = .01), were independently associated with 90-day mortality. Black (P = .021) and Hispanic (P = .016) OTRs were underrepresented among the vaccinated, especially in the ≥3-dose group. Conclusions Despite lower mRNA vaccine efficacy in OTRs and against Omicron variants, vaccination protects this vulnerable patient population from severe COVID-19 and death. Ethnic and racial disparities in health care have been exacerbated by the COVID-19 pandemic and warrant better community outreach efforts.
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Affiliation(s)
- Alexis Hope Lerner
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University , Providence, Rhode Island , USA
| | - Panos Arvanitis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University , Providence, Rhode Island , USA
| | - Kendra Vieira
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University , Providence, Rhode Island , USA
| | - Elizabeth Jessica Klein
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University , Providence, Rhode Island , USA
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University , Providence, Rhode Island , USA
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11
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Biswas S, Shahriar S, Giangreco NP, Arvanitis P, Winkler M, Tatonetti NP, Brunken WJ, Cutforth T, Agalliu D. Mural Wnt/β-catenin signaling regulates Lama2 expression to promote neurovascular unit maturation. Development 2022; 149:dev200610. [PMID: 36098369 PMCID: PMC9578690 DOI: 10.1242/dev.200610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022]
Abstract
Neurovascular unit and barrier maturation rely on vascular basement membrane (vBM) composition. Laminins, a major vBM component, are crucial for these processes, yet the signaling pathway(s) that regulate their expression remain unknown. Here, we show that mural cells have active Wnt/β-catenin signaling during central nervous system development in mice. Bulk RNA sequencing and validation using postnatal day 10 and 14 wild-type versus adenomatosis polyposis coli downregulated 1 (Apcdd1-/-) mouse retinas revealed that Lama2 mRNA and protein levels are increased in mutant vasculature with higher Wnt/β-catenin signaling. Mural cells are the main source of Lama2, and Wnt/β-catenin activation induces Lama2 expression in mural cells in vitro. Markers of mature astrocytes, including aquaporin 4 (a water channel in astrocyte endfeet) and integrin-α6 (a laminin receptor), are upregulated in Apcdd1-/- retinas with higher Lama2 vBM deposition. Thus, the Wnt/β-catenin pathway regulates Lama2 expression in mural cells to promote neurovascular unit and barrier maturation.
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Affiliation(s)
- Saptarshi Biswas
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Sanjid Shahriar
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nicholas P. Giangreco
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Panos Arvanitis
- Department of Biomedical Engineering, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Markus Winkler
- Faculty of Medicine, Institute of Anatomy, Ludwig-Maximilians Universität, Munich 80336, Germany
| | - Nicholas P. Tatonetti
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - William J. Brunken
- Department of Ophthalmology & Visual Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Tyler Cutforth
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Dritan Agalliu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
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12
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Mecadon K, Arvanitis P, Farmakiotis D, Rogers R. Single-center experience with nirmatrelvir/ritonavir in kidney transplant recipients on tacrolimus maintenance immunosuppression. Clin Transplant 2022; 36:e14752. [PMID: 35713302 DOI: 10.1111/ctr.14752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Krista Mecadon
- Department of Pharmacy, Rhode Island Hospital, Rhode Island, USA
| | - Panos Arvanitis
- Warren Alpert Medical School of Brown University, Rhode Island, USA
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Rhode Island, USA
| | - Ralph Rogers
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Rhode Island, USA
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13
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Arvanitis P, Johansson A, Frick M, Malmborg H, Gerovasileiou S, Larsson E, Blomstrom Lundqvist C. Timing and degree of left atrial stunning and reverse functional remodeling following electrical cardioversion in patients with recent onset atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) results in left atrial electrical, structural and functional remodeling. Restoration of sinus rhythm hallmarks the beginning of reverse remodeling, the extent of which may depend on the type of AF.
Purpose
The aim of the study was to assess resumption of left atrial function after electric cardioversion in patients with recent onset AF and to explore the association between reverse remodeling and the type of atrial fibrillation.
Methods
Patients with AF duration <48 hours were prospectively included. Trans-thoracic echocardiography was performed prior, immediately after (2–4 hours) and 7–10 days following CV. Left atrial volume index (LAVI), left atrial global longitudinal strain during reservoir (LAGLS-res), conduit (LAGLS-cond) and contractile (LAGLS-contr) phases, left atrial ejection fraction (LAEF) and left ventricular ejection fraction (LVEF) were measured.
Results
Forty-three patients (84% males) aged 55±9.6 years, (mean±SD), with median CHA2DS2-VASc score 1 (interquartile range 0–1) were included. Repeated measure analysis of variance revealed a statistically significant overall change for LAGLS-res F(2,78)=55.4, p<0,001, LAGLS-cond F(2,78)=23.3, p<0,001, LAGLS-contr F(2,78)=39.7, p<0,001, LAEF F(2,80)=28.5, p<0.001 and LVEF F(2,80)=8.4, p<0.001. At 7–10 days, LAGLS-contr 12±4%, LAEF 53±9% and LVEF 60±6 (mean±SD) return within normal reference intervals. Notably left atrial recovery seems to precede left ventricular recovery. No statistical significant interaction with the type of atrial fibrillation could be shown.
Conclusion
Left atrial functional reverse remodeling occurs within ten days after successful electric cardioversion of patients with recent onset atrial fibrillation.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung Foundation, Correvio International Sárl (Geneva Switzerland), Selanders Stiftelse
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Affiliation(s)
- P Arvanitis
- Uppsala University, Department of Medical Science and Cardiology, Uppsala, Sweden
| | - A.K Johansson
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - H Malmborg
- Uppsala University, Department of Medical Science and Cardiology, Uppsala, Sweden
| | - S Gerovasileiou
- Uppsala University Hospital, Department of Clinical Physiology and Cardiology, Uppsala, Sweden
| | - E.M Larsson
- Uppsala University, Department of Surgical Science, Radiology, Uppsala, Sweden
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14
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Arvanitis P, Johansson A, Frick M, Malmborg H, Larsson E, Blomstrom Lundqvist C. Activation of inflammatory/coagulation system following electrical cardioversion of patient with recent onset atrial fibrillation: an explorative study of the relation to white matter hyperintensities. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
White matter hyperintensities (WMH), assessed using Fazekas scale, are more prevalent in patients with atrial fibrillation (AF), although its pathophysiologic mechanism(s) is unclear.
Purpose
The study objective was to explore the association between cardiac, inflammatory and coagulation biomarkers and white matter hyperintensities in anticoagulant-naïve patients following electrical cardioversion (CV) of recent onset AF.
Methods
Patients with AF duration <48 hours were prospectively included. Brain magnetic resonance imaging (MRI), C-reactive protein (CRP), high-sensitivity troponin T (hs-TNT), NT-proBNP, Interleukin 6, P-selectin, D-dimer, prothrombin fragment 1+2, von Willebrand factor Ag, coagulation factor VIII C and fibrinogen, were obtained sequentially prior, after (2–4 hours) and 7–10 days following CV. Repeated measure analysis of variance was performed.
Results
Forty-three patients (84% males), aged 55±9.6 years, (mean±SD) with median CHA2DS2-VASc score 1 (interquartile range 0–1) were included. Sequential MRI showed no new brain lesions after CV, while WMH were present at baseline in 21/43 (49%) patients. Repeated measure analysis of variance revealed a statistically significant overall change for hs-TNT: F(2,84)=6.056, p=0.03, NT-proBNP: F(2,84)=106.02, p<0.001, P-selectin: F(2,84)=8.69, p<0.001 and vWF:Ag: F(2,84)=4.078, p=0.02. CRP, IL-6, coagulation factor VIII-C and fibrinogen showed the same pattern, however none reached statistical significance. Patients with WMH had persistent higher values for CRP, hs-TNT, D-dimer, prothrombin fragment 1+2 and fibrinogen prior and after CV, as values at 7–10 days coincided; however, statistical interaction was not significant.
Conclusion
Transient activation of inflammatory and coagulation systems during atrial fibrillation subsides within 7–10 days after electric cardioversion of recent onset atrial fibrillation. A tendency of higher degree of activation during atrial fibrillation was observed in patients with white matter hyperintensities.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung Foundation, Swedish Research Council, Correvio International Sárl (Geneva Switzerland), Selanders Stiftelse
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Affiliation(s)
- P Arvanitis
- Uppsala University, Department of Medical Science and Cardiology, Uppsala, Sweden
| | - A.K Johansson
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - H Malmborg
- Uppsala University, Department of Medical Science and Cardiology, Uppsala, Sweden
| | - E.M Larsson
- Uppsala University, Department of Surgical Science, Radiology, Uppsala, Sweden
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Larsson EM, Blomstrom Lundqvist C. P1080Magnetic resonance imaging after electrical cardioversion of recent-onset atrial fibrillation in anticoagulant-naive patients - a study exploring clinically silent cerebral lesions. Europace 2020. [DOI: 10.1093/europace/euaa162.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Unrestricted grants from the Swedish Heart-Lung Foundation, the Swedish Research Council, Correvio International Sárl (CH) and Selanders stiftelse
Background
Patients with atrial fibrillation (AF) have a high incidence of cognitive impairment, which may be related to clinically silent microembolism causing cerebral infarctions.
Purpose
To explore the occurrence and timing of silent brain lesions following electrical cardioversion (CV) of recent onset AF in anticoagulant-naïve patients and to further study related effects on cognitive function and biomarkers of cerebral damage, S100b.
Methods
Patients with AF duration < 48 hours were prospectively included. Brain magnetic resonance imaging (MRI) and S100b, were obtained prior, after and 7-10 days following CV. Trail making tests (TMT-A and TMT-B) and their difference, ΔΤΜΤ, were assessed prior to CV, 7-10 days and 30 days after CV.
Results
Forty-three patients (84% males) with mean CHA2DS2-VASc score 0.6 ± 0.7 were included. Sequential MRI, including diffusion weighted scans, showed no new brain lesions after CV.
Chronic white matter hyperintensities (WMH) were present at baseline in 21/43 (49%) patients. By partitioning the study population into four major groups according to the extend of WMH (Fazekas score 0 or ≥ 1) and the presence or absence of TE risk factors (CHA2DS2-VASc score 0 or ≥ 1), the TE risk as defined by CHA2DS2-VASc score ≥ 1, was associated with a higher incidence of WMH, Pearson χ2(1,N = 43)=3.95, p = 0.047.
The S100b (µg/l) levels increased significantly from baseline, (mean ± SD) 0.0472 ± 0.0182 to 0.0551 ± 0.0185 after CV, p = 0.001 and then decreased 7-10 days after CV to 0.0450 ± 0.0186, p < 0.001. Subgroup analysis according to the presence of at least one TE risk factor as defined by CHA2DS2-VASc score showed that statistical significance of repeated measures ANOVA was maintained; for patients with no risk factors F (2,30)=12.59, p < 0.001 and for patients with CHA2DS2-VASc score ≥1 F(2,36)=4.43, p < 0.019.
Consecutive TMT scores improved successively after CV, being statistically and clinically significant for TMT-B (p < 0.01) and ΔΤΜΤ (p = 0.005) between 7-10 days and 30 days after CV (Reliable Change Index >1.96).
Conclusion
New brain lesions could not be detected on MRI after CV, but the high incidence of white matter hyperintensities and the transient increase in S100b may indicate transient or minor brain damage undetectable by MRI thus heightening the need to reevaluate thromboembolic risk prior to CV even in low risk patients.
Abstract Figure. S100b_TMT
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Affiliation(s)
- P Arvanitis
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
| | - A K Johansson
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - H Malmborg
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
| | - E M Larsson
- Uppsala University, Uppsala University Hospital, Dep. of Radiology, Uppsala, Sweden
| | - C Blomstrom Lundqvist
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
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Wang M, Yan G, Yue W, Siu C, Tse H, Perperidis A, Cusack D, White A, Macgillivray T, Mcdicken W, Anderson T, Ryabov V, Shurupov V, Suslova T, Markov V, Elmstedt N, Ferm Widlund K, Lind B, Brodin LA, Westgren M, Mantovani F, Barbieri A, Bursi F, Valenti C, Quaglia M, Modena M, Peluso D, Muraru D, Dal Bianco L, Beraldo M, Solda' E, Tuveri M, Cucchini U, Al Mamary A, Badano L, Iliceto S, Goncalves A, Almeria C, Marcos-Alberca P, Feltes G, Hernandez-Antolin R, Rodriguez H, Maroto L, Silva Cardoso J, Macaya C, Zamorano J, Squarciotta S, Innocenti F, Guzzo A, Bianchi S, Lazzeretti D, De Villa E, Vicidomini S, Del Taglia B, Donnini C, Pini R, Mennie C, Salmasi AM, Kutyifa V, Nagy V, Edes E, Apor A, Merkely B, Nyrnes S, Lovstakken L, Torp H, Haugen B, Said K, Shehata A, Ashour Z, El-Tobgy S, Cameli M, Bigio E, Lisi M, Righini F, Franchi F, Scolletta S, Mondillo S, Gayat E, Weinert L, Yodwut C, Mor-Avi V, Lang R, Hrynchyshyn N, Kachenoura N, Diebold B, Khedim R, Senesi M, Redheuil A, Mousseaux E, Perdrix L, Yurdakul S, Erdemir V, Tayyareci Y, Memic K, Yildirimturk O, Aytekin V, Gurel M, Aytekin S, Gargani L, Fernandez Cimadevilla C, La Falce S, Landi P, Picano E, Sicari R, Smedsrud MK, Gravning J, Eek C, Morkrid L, Skulstad H, Aaberge L, Bendz B, Kjekshus J, Edvardsen T, Bajraktari G, Hyseni V, Morina B, Batalli A, Tafarshiku R, Olloni R, Henein M, Mjolstad O, Snare S, Folkvord L, Helland F, Torp H, Haraldseth O, Grimsmo A, Haugen B, Berry M, Zaghden O, Nahum J, Macron L, Lairez O, Damy T, Bensaid A, Dubois Rande J, Gueret P, Lim P, Nciri N, Issaoui Z, Tlili C, Wanes I, Foudhil H, Dachraoui F, Grapsa J, Dawson D, Nihoyannopoulos P, Gianturco L, Turiel M, Atzeni F, Sarzi-Puttini P, Stella D, Donato L, Tomasoni L, Jung P, Mueller M, Huber T, Sevilmis G, Kroetz F, Sohn H, Panoulas V, Bratsas A, Dawson D, Nihoyannopoulos P, Raso R, Tartarisco G, Gargani L, La Falce S, Pioggia G, Picano E, Gargiulo P, Petretta M, Cuocolo A, Prastaro M, D'amore C, Vassallo E, Savarese G, Marciano C, Paolillo S, Perrone Filardi P, Aggeli C, Felekos I, Roussakis G, Poulidakis E, Pietri P, Toutouzas K, Stefanadis C, Kaladaridis A, Skaltsiotis I, Kottis G, Bramos D, Takos D, Matthaios I, Agrios I, Papadopoulou E, Moulopoulos S, Toumanidis S, Carrilho-Ferreira P, Cortez-Dias N, Jorge C, Silva D, Silva Marques J, Placido R, Santos L, Ribeiro S, Fiuza M, Pinto F, Stoickov V, Ilic S, Deljanin Ilic M, Kim W, Woo J, Bae J, Kim K, Descalzo M, Rodriguez J, Moral S, Otaegui I, Mahia P, Garcia Del Blanco L, Gonzalez Alujas T, Figueras J, Evangelista A, Garcia-Dorado D, Takeuchi M, Kaku K, Otani K, Iwataki M, Kuwaki H, Haruki N, Yoshitani H, Otsuji Y, Kukucka M, Pasic M, Unbehaun A, Dreysse S, Mladenow A, Kuppe H, Hetzer R, Rajamannan N, Yurdakul S, Tayyareci Y, Tanrikulu A, Yildirimturk O, Aytekin V, Aytekin S, Kristiansson L, Gustafsson S, Lindmark K, Henein MY, Evdoridis C, Stougiannos P, Thomopoulos M, Fosteris M, Spanos P, Sionis G, Giatsios D, Paschalis A, Sakellaris C, Trikas A, Yong ZY, Boerlage-Van Dijk K, Koch K, Vis M, Bouma B, Piek J, Baan J, Abid L, Frikha Z, Makni K, Maazoun N, Abid D, Hentati M, Kammoun S, Barbier P, Staron A, Cefalu' C, Berna G, Gripari P, Andreini D, Pontone G, Pepi M, Ring L, Rana B, Ho S, Wells F, Yurdakul S, Tayyareci Y, Yildirimturk O, Dogan A, Aytekin V, Aytekin S, Karaca O, Guler G, Guler E, Gunes H, Alizade E, Agus H, Gol G, Esen O, Esen A, Turkmen M, Agricola E, Ingallina G, Ancona M, Maggio S, Slavich M, Tufaro V, Oppizzi M, Margonato A, Orsborne C, Irwin B, Pearce K, Ray S, Garcia Alonso C, Vallejo N, Labata C, Lopez Ayerbe J, Teis A, Ferrer E, Nunez Aragon R, Gual F, Pedro Botet M, Bayes Genis A, Santos CM, Carvalho M, Andrade M, Dores H, Madeira S, Cardoso G, Ventosa A, Aguiar C, Ribeiras R, Mendes M, Petrovic M, Petrovic M, Milasinovic G, Vujisic-Tesic B, Nedeljkovic I, Zamaklar-Trifunovic D, Petrovic I, Draganic G, Banovic M, Boricic M, Villarraga H, Molini-Griggs Bs C, Silen-Rivera Bs P, Payne Mph Ms B, Koshino Md Phd Y, Hsiao Md J, Monivas Palomero V, Mingo Santos S, Mitroi C, Garcia Lunar I, Garcia Pavia P, Castro Urda V, Toquero J, Gonzalez Mirelis J, Cavero Gibanel M, Fernandez Lozano I, Oko-Sarnowska Z, Wachowiak-Baszynska H, Katarzynska-Szymanska A, Trojnarska O, Grajek S, Bellavia D, Pellikka P, Dispenzieri A, Oh JK, Polizzi V, Pitrolo F, Musumeci F, Miller F, Ancona R, Comenale Pinto S, Caso P, Severino S, Cavallaro C, Vecchione F, D'onofrio A, Calabro' R, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Cosin-Aguilar J, Pinamonti B, Iorio A, Bobbo M, Merlo M, Barbati G, Massa L, Faganello G, Di Lenarda A, Sinagra GF, Ishizu T, Seo Y, Enomoto M, Kameda Y, Ishibashi N, Inoue M, Aonuma K, Saleh A, Matsumori A, Negm H, Fouad H, Onsy A, Hamodraka E, Paraskevaidis I, Kallistratos M, Lezos V, Zamfir T, Manetos C, Mavropoulos D, Poulimenos L, Kremastinos D, Manolis A, Citro R, Rigo F, Ciampi Q, Patella M, Provenza G, Zito C, Tagliamonte E, Rotondi F, Silvestri F, Bossone E, Monivas Palomero V, Mingo Santos S, Beltran Correas P, Gutierrez Landaluce C, Mitroi C, Garcia Lunar I, Gonzalez Mirelis J, Cavero Gibanel M, Gomez Bueno M, Segovia Cubero J, Beladan C, Matei F, Popescu B, Calin A, Rosca M, Boanta A, Enache R, Savu O, Usurelu C, Ginghina C, Ciobanu AO, Dulgheru R, Magda S, Dragoi R, Florescu M, Vinereanu D, Silva Marques J, Robalo Martins S, Jorge C, Calisto C, Goncalves S, Ribeiro S, Barrigoto I, Carvalho De Sousa J, Almeida A, Nunes Diogo A, Sargento L, Satendra M, Sousa C, Lousada N, Palma Reis R, Schiano Lomoriello V, Esposito R, Santoro A, Raia R, Schiattarella P, Dores E, Galderisi M, Mansencal N, Caille V, Dupland A, Perrot S, Bouferrache K, Vieillard-Baron A, Jouffroy R, Moceri P, Liodakis E, Gatzoulis M, Li W, Dimopoulos K, Sadron M, Seguela PE, Arnaudis B, Dulac Y, Cognet T, Acar P, Shiina Y, Gatzoulis M, Uemura H, Li W, Kupczynska K, Kasprzak J, Michalski B, Lipiec P, Carvalho V, Almeida AMG, David C, Marques J, Silva D, Cortez-Dias N, Ferreira P, Amaro M, Costa P, Diogo A, Tritakis V, Ikonomidis I, Paraskevaidis I, Lekakis J, Tzortzis S, Kadoglou N, Papadakis I, Trivilou P, Koukoulis C, Anastasiou-Nana M, Bombardini T, Picano E, Gherardi S, Arpesella G, Maccherini M, Serra W, Magnani G, Del Bene R, Pasanisi E, Sicari R, Startari U, Panchetti L, Rossi A, Piacenti M, Morales M, Mansencal N, El Hajjaji I, El Mahmoud R, Digne F, Dubourg O, Gargani L, Agoston G, Moreo A, Pratali L, Moggi Pignone A, Pavellini A, Doveri M, Musca F, Varga A, Picano E, Pratali L, Faita F, Rimoldi S, Sartori C, Alleman Y, Salinas Salmon C, Villena M, Scherrer U, Picano E, Sicari R, Baptista R, Serra S, Castro G, Martins R, Salvador M, Monteiro P, Silva J, Szudi L, Temesvary A, Fekete B, Kassai I, Szekely L, Abdel Moneim SS, Martinez M, Mankad S, Bernier M, Dhoble A, Pellikka P, Chandrasekaran K, Oh J, Mulvagh S, Hong GR, Kim JY, Lee SC, Choi SH, Sohn IS, Seo HS, Choi JH, Cho KI, Yoon SJ, Lim SJ, Lipiec P, Wejner-Mik P, Kusmierek J, Plachcinska A, Szuminski R, Kasprzak J, Stoebe S, Tarr A, Trache T, Hagendorff A, Mor-Avi V, Yodwut C, Jenkins C, Kuhl H, Nesser H, Marwick T, Franke A, Niel J, Sugeng L, Lang R, Gustafsson S, Henein M, Soderberg S, Lindmark K, Lindqvist P, Necas J, Kovalova S, Saha SK, Kiotsekoglou A, Toole R, Govind S, Gopal A, Amzulescu MS, Florian A, Bogaert J, Janssens S, Voigt J, Parisi V, Losi M, Parrella L, Contaldi C, Chiacchio E, Caputi A, Scatteia A, Buonauro A, Betocchi S, Rimbas R, Dulgheru R, Mihaila S, Vinereanu D, Caputo M, Navarri R, Innelli P, Urselli R, Capati E, Ballo P, Furiozzi F, Favilli R, Mondillo S, Lindquist R, Miller A, Reece C, O'leary P, Cetta F, Eidem BW, Cikes M, Gasparovic H, Bijnens B, Velagic V, Kopjar T, Biocina B, Milicic D, Ta-Shma A, Nir A, Perles Z, Gavri S, Golender J, Rein A, Pinnacchio G, Barone L, Battipaglia I, Cosenza A, Marinaccio L, Coviello I, Scalone G, Sestito A, Lanza G, Crea F, Cakal S, Eroglu E, Ozkan B, Kulahcioglu S, Bulut M, Koyuncu A, Acar G, Alici G, Dundar C, Esen A, Labombarda F, Zangl E, Pellissier A, Bougle D, Maragnes P, Milliez P, Saloux E, Aggeli C, Lagoudakou S, Felekos I, Gialafos E, Poulidakis E, Tsokanis A, Roussakis G, Stefanadis C, Nagy A, Kovats T, Apor A, Vago H, Toth A, Sax B, Kovacs A, Merkely B, Elnoamany MF, Badran H, Abdelfattah I, Khalil T, Salama M, Butz T, Taubenberger C, Thangarajah F, Meissner A, Van Bracht M, Prull M, Yeni H, Plehn G, Trappe H, Rydman R, Bone D, Alam M, Caidahl K, Larsen F, Staron A, Gasior Z, Tabor Z, Sengupta P, Liu D, Niemann M, Hu K, Herrmann S, Stoerk S, Morbach C, Knop S, Voelker W, Ertl G, Weidemann F, Cawley P, Hamilton-Craig C, Mitsumori L, Maki J, Otto C, Astrom Aneq M, Nylander E, Ebbers T, Engvall J, Arvanitis P, Flachskampf F, Duvernoy O, De Torres Alba F, Valbuena Lopez S, Guzman Martinez G, Gomez De Diego J, Rey Blas J, Armada Romero E, Lopez De Sa E, Moreno Yanguela M, Lopez Sendon J, Aggeli C, Felekos I, Poulidakis E, Trikalinos N, Siasos G, Aggeli A, Roussakis G, Stefanadis C, Tomaszewski A, Kutarski A, Tomaszewski M, Ikonomidis I, Lekakis J, Tritakis V, Tzortzis S, Kadoglou N, Papadakis I, Trivilou P, Anastasiou-Nana M, Koukoulis C, Paraskevaidis I, Vriz O, Driussi C, Bettio M, Pavan D, Bossone E, Antonini Canterin F, Doltra Magarolas A, Fernandez-Armenta J, Silva E, Solanes N, Rigol M, Barcelo A, Mont L, Berruezo A, Brugada J, Sitges M, Ciciarello FL, Mandolesi S, Fedele F, Agati L, Marceca A, Rhee S, Shin S, Kim S, Yun K, Yoo N, Kim N, Oh S, Jeong J, Alabdulkarim N. Poster Session 4: Friday 9 December 2011, 14:00-18:00 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Watanabe E, Sobue Y, Osaka M, Ozaki Y, Kodama I, Tanabe T, Aizawa Y, Lousinha A, Oliveira M, Silva Cunha P, Nogueira Silva M, Lopes J, Silva S, Carlos I, Cruz Ferreira R, Chiladakis I, Kalogeropoulos A, Koutsogiannis N, Zagkli F, Arvanitis P, Alexopoulos D, Sepsi M, Kadlecova V, Zeman M, Sindler M, Gaillyova R, Vasku A, Kozak M, Krivan L, Talib A, Sato N, Talib A, Nakagawa N, Sakamoto N, Takeuchi T, Kawamura Y, Hasebe N. Non invasive of risk stratification sudden cardiac death. Europace 2011. [DOI: 10.1093/europace/eur216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pipilis A, Andrikopoulos G, Lekakis J, Zavitsanakis P, Theoharis A, Theodosis A, Liolios C, Papakosmas L, Arvanitis P, Kosmopoulou S, Richter D, Goudevenos J. Temporal and spatial distribution of ST-elevation myocardial infarction admissions in a countrywide registry. Int J Cardiol 2010; 142:172-6. [DOI: 10.1016/j.ijcard.2008.12.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 12/05/2008] [Accepted: 12/14/2008] [Indexed: 10/21/2022]
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Treguer F, Mabo P, Tassin A, Prunier F, Furber A, Daubert JC, Solnon A, Dupuis JM, Jarverud K, Broome M, Noren K, Svensson T, Hjelm S, Bjorling A, Val-Mejias JE, Doshi S, Kroll M, Oza A, Shah S, Doshi SK, Val-Mejias JE, Pittaro M, Reeves R, Payne J, Kroll M, Graumann R, Oza A, Maury P, Raczka F, Pasquie JL, Beck L, Taieb J, Qu F, Shah R, Hallier B, Gutleben K, Brachmann J, Vogt J, Boriani G, Bowes R, Casset C, Krumel F, Johansson I, Blixt F, Andersson F, Stromberg A, Perzanowski C, Irnich W, Larsen P, Lever N, Wasniewski M, Mitkowski P, Baszko A, Ochotny R, Grajek S, Deering TF, Golman DS, Epstein A, Greenberg S, Gupta M, Lee K, Hero M, Magne I, Souques M, Moro E, Marcon C, Allocca G, Marras E, Sitta N, Da Soghe M, Varbaro A, Delise P, Chiladakis I, Kalogeropoulos A, Koutogiannis N, Arvanitis P, Zagli F, Nikokiris G, Alexopoulos D, Szydlo K, Wita K, Trusz-Gluza M, Tabor Z, Anichkov D, Shostak N, Platonova A, Polovina M, Potpara T, Grujic M, Mujovic N, Carmo P, Adragao P, Cavaco D, Parreira L, Santos K, Morgado F, Marcelino S, Silva A, Rumeau P, Maury P, Duparc A, Hebrard A, Mondoly P, Rollin A, Delay M, Mizutani N, Yonemoto T, Fukuta M, Ito T, Herrera Siklody C, Blum T, Schiebeling-Roemer J, Restle C, Weber R, Stockinger J, Kalusche D, Arentz T, Fouche R, Fromentin S, Lassabe G, Sager C. Poster Session 2: Sudden death and ICD: technical aspects. Europace 2009. [DOI: 10.1093/europace/euq217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Arvanitis P, Stratoudakis A, Alexandrou C. Secondary orbital implant insertion in an anophthalmic patient after orbital reconstruction. Orbit 2007; 26:275-7. [PMID: 18097967 DOI: 10.1080/01676830601168967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors report the case of a 20-year-old man who underwent enucleation of his right eye with teratoma when he was an infant, without volume replacement by an implant. As a result, an underdeveloped shallow bony orbit finally occurred. Also, a contracted socket was present with shallow lower fornix, making ophthalmic prosthesis fitting almost impossible. The patient underwent surgical reconstruction of the orbit with expansion of the orbit vertically and horizontally. A secondary implant with an adequate volume was inserted to correct the orbital volume deficit. The previous expansion of the orbit allowed the insertion of an 18 mm-diameter hydroxyapatite implant wrapped in fascia lata. The lower fornix was expanded with a mucosal graft in order to overcome the socket contraction and the conjunctival shortage. The authors conclude that the final result of this approach is satisfactory. Almost 20 years after enucleation of an eye with teratoma, an attempt was made to correct most of the difficult problems dealing with a malformed shallow orbit and a contracted socket. The young patient is now able to wear a fine ophthalmic prosthesis and his appearance is greatly improved.
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Affiliation(s)
- P Arvanitis
- Hellenic Craniofacial Center, Athens, Greece.
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Arvanitis P, Plichta SB. Perceptions of quality: predictors of positive ratings in a military health care system. Mil Med 2000; 165:77-80. [PMID: 10658434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- P Arvanitis
- Branch Medical Clinic, Norfolk Naval Shipyard, Portsmouth, VA 23709-5000, USA
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Atkins MS, McKay MM, Arvanitis P, London L, Madison S, Costigan C, Haney P, Zevenbergen A, Hess L, Bennett D, Webster D. An ecological model for school-based mental health services for urban low-income aggressive children. J Behav Health Serv Res 1998; 25:64-75. [PMID: 9516295 DOI: 10.1007/bf02287501] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An ecological model for school-based mental health services that targets urban low-income aggressive children--a highly vulnerable and underserved population--is presented. The goals of the model are to increase children's and teachers' involvement in the delivery of services and to increase the integration of these services into existing school resources and activities. The model proposes that mental health service providers work in collaboration with teachers to deliver services that (1) can be managed by existing school resources and personnel, (2) are related to empirically based factors associated with reduced aggression and increased social functioning, and (3) are group administered to increase the number of children served and to reduce stigmatization associated with mental health services. The model is individualized and flexible by acknowledging that contexts for aggression differ across classrooms and children and by providing services specific to those contexts. Two studies are presented illustrating the application of this model to decrease aggression and increase academic engagement in low-income urban public schools.
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Affiliation(s)
- M S Atkins
- Department of Psychiatry, University of Illinois at Chicago 60612-7347, USA.
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Damanakis A, Ikonomopoulos N, Alatsaki M, Arvanitis P. Effect of posterior fixation sutures on the accommodative element of partially accommodative strabismus. Ophthalmologica 1994; 208:71-6. [PMID: 8183528 DOI: 10.1159/000310456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In a prospective study, we investigated the effect of posterior fixation sutures on the accommodative element of partially accommodative strabismus. Twenty patients were included in the study. Recession of one or both medial rectus muscles combined with bilateral posterior fixation sutures was performed on each patient. The results showed that this combined operation had a greater effect on the angle without glasses at both distance and near fixation, but not enough to eliminate the angle without glasses in all the cases. The results in patients with convergence excess are not satisfactory, as far as the reduction of the angle without glasses is concerned. In patients without convergence excess, this operation is effective in satisfactorily reducing the squint without glasses when the difference of the angle with and without glasses does not exceed 15 delta.
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Affiliation(s)
- A Damanakis
- Department of Ophthalmology, Athens University School of Medicine, Greece
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